New Test Identifies Early-Stage Melanoma With Metastatic Risk

Because two-thirds of melanoma patients who die or experience metastatic disease are initially diagnosed with early-stage disease, it is important to determine risk for metastasis in patients with early-stage melanoma. About 75% of patients with melanoma have early disease (stage I or II) at diagnosis.

A prognostic 28-gene signature (DecisionDx-Melanoma, Castle Biosciences) could predict which patients with stage I or II melanoma are at high risk for metastasis, and could alter the clinical management of these patients, according to aconfirmatory study published in the January 1 issue of Clinical Cancer Research.The 28-gene signature predicts a patient’s risk for metastasis, independent of American Joint Committee on Cancer (AJCC) melanoma staging, Breslow thickness, ulceration, mitotic rate, and age.

“The behavior of melanoma tumors is highly variable, and often cannot be accurately predicted using traditional staging methods,” said senior author Pedram Gerami, MD, professor of dermatology and director of melanoma research at the Northwestern Skin Cancer Institute at Northwestern University in Chicago, in a press release from the manufacturer.

“These results demonstrate that a gene signature can accurately predict metastasis, particularly in tumors that were assumed to be lower risk due to stage, size, and other characteristics. This test can have a significant impact on the management and potentially long-term outcomes of these melanoma patients,” he added.

The dataset supporting the 28-gene signature is small, but the data are compelling, said Jeffrey J. Sussman, MD, professor of surgery and chief of the division of surgical oncology at the University of Cincinnati School of Medicine, who was not involved in the study.

In his clinical practice, he orders the test for patients with node-negative disease with higher risk factors (stage IIa/IIb) in an effort to stratify risk for metastasis, he told Medscape Medical News.